Ever find yourself stuck doing a bunch of research when an erector spinae block is performed? Or how about staring down an iPACK block note?
Well, great news is coming your way! CPT has created new codes for thoracic and lower extremity fascial plane blocks.
Starting January 2025, new codes 64466 – 64474 for fascial plane blocks will go live. Look at the codes below—you’ll notice that we now have both unilateral and bilateral options for thoracic fascial plane blocks. Additionally, note that both thoracic and extremity fascial plane blocks have specific code assignments based on whether an injection or continuous infusion is performed. All these codes will include imaging guidance, if performed.
This is great news, as these codes will replace the need for endless searching, only to come up with the dreaded unlisted code 64999 for procedures like quadratus lumborum blocks, erector spinae, pectoral blocks (PECS I & II), fascia iliaca, and the IPACK block (popliteal region).
| Code | Description |
| 64466 | Unilateral thoracic fascial plane block by injection(s), with imaging guidance when performed |
| 64467 | Unilateral thoracic fascial plane block by continuous infusion(s), with imaging guidance when performed |
| 64468 | Bilateral thoracic fascial plane block by injection(s), with imaging guidance when performed |
| 64469 | Bilateral thoracic fascial plane block by infusion(s), with imaging guidance when performed |
| 64473 | Unilateral lower extremity fascial plane block by injection(s), with imaging guidance when performed |
| 64474 | Unilateral lower extremity fascial plane block by infusion(s), with imaging guidance when performed |
Emily Lomaquahu, CPC, CPMA, CEDC
Senior Coding Quality Auditor & Educator
Emily is a Senior Coding Quality Auditor for Haugen Consulting Group and brings over a decade of experience to the profee team! She began her career as an auditor and with her keen eye for detail, she quickly found it was a perfect fit. Emily thrives in a collaborative environment and enjoys creating high-quality trainings to help providers and coders navigate charts and improve their accuracy. She earned a bachelor’s degree from the University of Colorado, in Denver. Emily specializes in Evaluation and Management (E/M), Primary Care, Anesthesia, Emergency Department, and Neurology, though she says Anesthesia and Neurology are her favorites! She is a Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA), and Certified Emergency Department Coder (CEDC).
Our physicians perform infrainguinal fascia iliaca nerve blocks. Would 64473 be correct to bill for infrainguinal fascia iliaca nerve blocks? Thank you!
Hi Lisa – This will depend on documentation and what the target of the block is. If the target really is the inguinal nerve, then code 64425 is appropriate. If the target is the fascia iliaca plane, below the inguinal area, then go with 64473.
Infrainguinal is defined as the area below the inguinal ligament. The fascia iliaca layer is located here. So, the target is not the nerve itself but the fascia iliaca, code 64473.
If the patient is receiving a ESP block that is NOT in relation to post operative pain management from same day surgery, but a stand along procedure due to chronic back pain from previously performed back surgery, would CPT 64461 be appropriate or CPT 64999?
There are new fascial plane block codes that cover the erector spinae plane. 64466 and 64467. We would recommend these codes if this is what was performed. These codes remain the same whether they are used for stand-alone or post op pain.
Can I charge for a 64450 and a 64473 for the same surgical encounter? Injections given in different areas of the body.
These two codes do not hit an NCCI edit. If you have a case where the documentation supports a lower extremity fascial plane block (64473) and peripheral nerve block (64450) at a different anatomical site, they can be reported during the same encounter.
Remember, nerve blocks target specific nerves directly, while fascial plane blocks target the spaces between fascial layers, with the intent to block nerves within or that cross through those layers. So be sure to review the procedure notes carefully.
What will be the new CPT code for : Pericapsular Nerve Group( PENG) , right side ultrasound guided?
Hi Matilda, PENG procedures would be reported with the new fascial plane block codes 64473 or 64474. Ultrasound guidance is included with these codes when performed and would not be reported separately.
I just want to clarify, quadratus lumborum would fall under TAP 64486/64488 and new codes would apply to Pecs I, Pecs II, ESP, SP, TTMP, iPack
You are correct that the injection of a quadratus lumborum fascial block would be reported with TAP codes 64486 or 84488.
In the CPT Assistant’s article ‘Reporting Fascial Plane Codes’ in November 2024, they reference the new CPT codes and the guideline wording change:
“In addition, the guidelines in the Introduction/Injection of Anesthetic Agent (Nerve Block), Diagnostic or Therapeutic Somatic Nerves subsection have been revised by replacing the term “transverse abdominis plane (TAP) block” with “abdominal fascial plane block” to align with the language in the descriptors of the new codes and to clarify the appropriate codes to report for abdominal FPB procedures not limited to TAP block (eg, quadratus lumborum block).”
The new codes (64466-64469) apply to the other fascial blocks you mentioned, ie. Pecs I, Pecs II, ESP, SP, TTMP and iPack.
We hope this is helpful.
can 64466 be reported twice for PEC I and II blocks performed at the same operative session?
That is a great question. We do not see any official MUE information for these new fascial plane codes yet. Our recommendation is treat this situation in the same fashion as you would have before the new codes existed. If the documentation supports both a PEC I and PEC II, report both with 64466 and the appropriate X modifier (or modifier 59), along with a laterality modifier to indicate that this was not a bilateral procedure. We cannot state for certain that both will be reimbursed. So, we also recommend checking for specific payors policies.
We expect to see coding clarifications as these new codes continue to be utilized and will be keeping an eye out for any updates.
What about LUMBAR erector spinae plane blocks? Use the Thoracic codes?
HI Nameer, Great question! The new thoracic fascial plane block codes appear to be specific to the thoracic region. Given the information currently available, for an erector spinae block located specifically in the lumbar region, we might recommend an unlisted code. However, this would be dependent on the documentation. We will be on the lookout for further guidance and clarification on proper use as these new fascial plane block codes begin to be used more frequently.
Any update on the use of the unlisted code for lumbar esp injections?
Hi, We have not seen any updates to the instructions for reporting lumbar esp. injections.
Do bilateral same blocks need separate notes?
Hi Hongping, Typically, a bilateral procedure will not require two separate procedure notes. The bilateral procedure may be documented in a single note, but they should clearly indicate that the procedure was performed on both sides.
Will the new 64473/64474 CPT codes include the Adductor Canal Block & the Popliteal Block since they are both plane blocks?
Thanks for the question! A plane is the space between discrete fascial layers. Procedures in which a fascial plane is targeted, rather than a specific nerve, would be covered by the new codes. Quadratus lumborum, erector spinae, PECS, fascia iliaca and iPacks (infiltration between popliteal artery and capsule of the knee), are specifically described as fascial plane injections and would be covered by these new codes. To the best of our knowledge adductor canal blocks and popliteal blocks targeted at specific nerves will continue to be coded as they are now. We will be watching for further clarification from CPT once these codes go into effect.
what code should be used for 64467 and 64469 day after injection 01996? or 99231?
what about the extremity 64474 99231?
Hi Patricia, We would not recommend 01966, as these are not epidural or subarachnoid infusions. In our view this situation would be treated the same as when a peripheral nerve continuous catheter is in place.
We recommend E/M code with (e.g. 99231) for the new fascial plane pain block continuous infusions.